Colonic transit study protocol

SITZMARKS diagnostic test helps physicians select the best therapeutic option, based on colon transit time, for adult patients with severe constipation who have otherwise negative GI evaluations.

• Convenient gelatin capsules
• Efficient pre-cut radiopaque rings
• Time saving and cost effective
• CPT code 99070
• 10 capsules per package; each capsule contains 24 Radiopaque polyvinyl chloride markers of 1 mm X 4.5 mm 浙江中医药大学附属第二医院消化内科刘福
  Patient takes one SITZMARKS capsule on day 0 by mouth with water. X-ray on day 5.

Patient takes one SITZMARKS capsule daily for three days by mouth with water. X-ray on day 7.

Indication: Adult patients with severe constipation but otherwise negative GI evaluations. SITZMARKS are to be dispensed only by physicians to patients for oral intake.

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SUGGESTED DIRECTIONS TO THE PHYSICIAN:

(1 capsule: each capsule contains 24 markers)

Step 1:
1. On day 0, direct patient to take SITZMARKS capsule by mouth with
    water, preferably with confirmation by office observation. Instruct
    patient to abstain from using laxatives, enemas or suppositories of any
    kind for 5 days.
2. Arrange a flat-plate abdominal X-ray on day 5 to determine the
    location and the extent of elimination of the radiopaque markers.
3. Patients who expel at least 80% (19 or more) markers have grossly
    normal colonic transit.
4. Patients who retain 6 or more markers may have follow-up abdominal
    X-rays within several days.
5. For patients whose markers accumulate in the rectosigmoid or when
    markers are retained diffusely, Step 2 may be warranted.

Step 2: If more than 20% (5-6 markers) are retained by day 5:
1. Instruct patient to take a bulking agent (such as KONSYL) daily for
    1 to 2 weeks. Encourage liquid intake to maximize product efficacy.
2. Instruct patient to take another SITZMARKS capsule in 1 to 2 weeks
    and repeat X-rays in 5 days to determine location and extent of
    elimination of the markers.

Reading the Results:
If over 80% of the markers are passed by day 5, colonic transit is grossly normal. If remaining markers are scattered about the colon, the condition is most likely hypomotilty or colonic inertia. If remaining markers are accumulated in the rectum or rectosigmoid, the condition is most likely functional outlet delay, e.g., internal rectal prolapse, anismus.

A. If 5 or fewer markers remain, patient has grossly normal colonic transit.

B. Most rings are scattered about the colon. Patient most likely has hypomotility or colonic inertia.

C. Most rings are gathered in the rectosigmoid. Patient has functional outlet obstruction.

(3 capsules: each capsule contains 24 markers ? available in 3
different shapes)

Metcalf Protocol:
1. On day 0, day 1, and day 2, administer one SITZMARKS capsule,
    (patients should be instructed to take the O marker on day 0, the
    Double D markers on day 1, and the Tri-Chamber markers on day 2),
    by mouth with water, preferably with confirmation by office observation.
    Instruct patient to abstain from using laxatives, enemas or
    suppositories of any kind for 5 days.
2. Arrange a flat-plate abdominal X-ray on day 4 and, if necessary, again
    on day 7 to determine location and the extent of elimination of the
    radiopaque markers.
3. The total number of markers in each segment is used to determine
    transit time regardless of the type.

	Right Colon	Left Colon	Rectosigmoid	Colon
4th day	12	14	14	40
7th day	0	0	2	2
Transit Time	12 hours	14 hours	16 hours	42 hours

 

Normal Values:
Right Colon	=	11.3 hours
Left Colon	=	11.3 hours
Rectosigmoid	=	12.4 hours
Total		35 hours

4. If, on day 4, there are more than a total of 50 markers, transit time is
    abnormal and an X-ray needs to be taken on day 7.
5. If total colonic transit time is more than 70 hours, then transit in any segment is
    abnormal if  more than 30 hours.